Neurologic Sequellae of Nutritional Deficiencies 03

Topic: Imaging

A 59 year-old man presents with worsening ophthalmoparesis, ataxia, nystagmus, and confusion. An MRI of his brain is obtained, and is shown above.Appropriate treatment requires IV administration of which of following?

This answer is incorrect.

C) vitamin B1

This answer is correct.

This FLAIR MRI shows hyperintensity in the medial thalamic nuclei, which is characteristic of Wernicke encephalopathy and Korsakoff dementia. The typical symptoms of Wernicke encephalopathy include ophthalmoparesis, nystagmus, ataxia, and a change in mental status characterized by confusion and apathy. Wernicke encephalopathy and Korsakoff dementia are both due to a deficiency of thiamine (vitamin B1), and both are more common in alcoholics. Treatment of Wernicke encephalopathy requires administration of thiamine. Adams and Victor recommend 50mg IV and 50mg IM immediately, followed by 50mg IM daily. (See References)